The Michigan Department of Community Health (MDCH) has released its findings from a public health investigation initiated in April 2007 after allegations of unsafe sanitation practices were made against Dr. Robert Stokes, a Grand Rapids area dermatologist on trial for health care fraud.

The Kent County Health Department sent more than 13,000 letters to patients of Dr. Stokes, recommending testing for hepatitis B, hepatitis C and HIV. In response to these letters and the widespread media coverage of the trial, laboratory tests were conducted on samples collected from 776 individuals for possible exposure to these blood borne pathogens. These individuals were screened at free clinics sponsored by the Kent County Health Department and the Mid-Michigan District Health Department. Of these 776 patients, six (0.77 percent) were found to be positive for hepatitis C infection, none were positive for hepatitis B infection and none were positive for HIV infection. Investigators are unable to determine when these individuals became infected with hepatitis C, only that they are currently infected. It is important to note that this group of 776 is only a small portion of all the patients treated by Dr. Stokes. It is likely that many of his patients chose to be tested in a private health care setting, and therefore their information is not included in this summary.

In addition to the testing clinics, MDCH staff compared existing, secure and confidential, databases of reportable diseases, to the list of Dr. Stokes' patients, based on available medical records. Two patients of Dr. Stokes had been previously reported as positive for HIV, 13 were positive for hepatitis C, and none were positive for hepatitis B. The information available to the state and local health departments during the investigation was insufficient to determine if anyone was infected due to an exposure in Dr. Stokes clinics, although the likelihood of transmission in this setting is very low.

The Centers for Disease Control and Prevention estimates 1.6 percent of the U.S. population has ever been infected with hepatitis C. Although 80 percent of persons infected with hepatitis C will not have symptoms, symptoms can include: jaundice, fatigue, dark urine, abdominal pain, loss of appetite and nausea. While some people can clear the infection, 75 percent to 85 percent become chronically infected with cirrhosis of the liver occurring in 20 percent of chronically infected persons. Hepatitis C is spread when blood from an infected person enters the body of a person who is not infected, usually through sharing needles or "works" when injecting drugs, through needlesticks or sharps exposures on the job, or from an infected mother to her baby during birth. There is no vaccine to prevent hepatitis C. It is estimated that 60-70 percent of those infected with hepatitis C are unaware of their infection.

To prevent becoming exposed to hepatitis C:

- Do not inject or "shoot" drugs; if you inject drugs, stop and get into a treatment program; if you can't stop, never share needles, syringes, water, or "works", and get vaccinated against hepatitis A & B.

- Do not share personal care items that might have blood on them (razors, toothbrushes).

- If you are a health care or public safety worker, always follow routine barrier precautions and safely handle needles and other sharps; get vaccinated against hepatitis B.

- Consider the risks if you are thinking about getting a tattoo or body piercing. You might get infected if the tools have someone else's blood on them or if the artist or piercer does not follow good health practices.

- HCV can be spread by sex, but this is rare. If you are having sex with more than one steady sex partner, use latex condoms correctly and every time to prevent the spread of sexually transmitted diseases. You should also get vaccinated against hepatitis B.

- If you are HCV positive, do not donate blood, organs, or tissue. For more information about hepatitis C infection, please go to http://www.cdc.gov/ncidod/diseases/hepatitis/c/index.htm.